The environment in which hospital nurses operate is a breeding ground for errors and will continue to threaten patient safety until it is substantially transformed, according to a new report by the Institute of Medicine. Nurses are overburdened with work, their reaction time is dulled by long hours, and their continuing education on new techniques and technologies often is scaled back by cost pressures, the report said. Although the nation's 2.2 million registered nurses, 700,000 licensed practical nurses and 2.3 million nursing assistants make up more than half of all care providers, their interests and say-so in patient care have been eroded by cutbacks in nursing management and leadership, according to the report.
Among its recommendations for improvement, the IOM called for changes in how hospitals set nurse-staffing levels and mandatory limits on work hours. The advisory agency urged state regulators to prohibit nurses from working more than 12 hours per day and more than 60 hours per week. At the same time, it said healthcare facilities should avoid using nurses from temporary agencies because of their lack of familiarity with the work environment. Instead, to accommodate unpredicted variations in patient volume or acuity, hospitals should provide for elasticity in the staffing schedule to handle increased workloads midshift, the IOM report said. In addition, hospitals should follow other methods to preserve safe staffing levels, such as giving nurses authority to halt admissions to their units when staffing is determined to be inadequate for safe patient care.
The IOM report also called on lawmakers and regulators to improve the work environment for nursing. For example, it recommended that regulators and various experts jointly convene to identify ways to safely reduce the burden of patient and work-related documentation. And it urged Congress to pass legislation that would extend peer-review protections to data collected internally by hospitals or shared with outside agencies solely for the purpose of improving safety and quality. Read the IOM report. -- by John Morrissey